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Oral cancer: How to cope with the condition

Oral cancer is taxing -- physically and emotionally. We tell you how you can cope with the condition and take care of yourself.

Written by Dr Anitha Anchan |Published : March 19, 2018 10:14 AM IST

Oral cancer is one of the top three cancers in India. It may originate in any of the tissues of the mouth. It could also be a result of metastasis (spread) from a different part of the body. It is known to affect people in the age group of 50-60 years. But in recent times, with youngsters having easy access to tobacco products has caused an increase in oral cancer incidences in 20-35 years age group. Even if you know that smoking and chewing tobacco put you at a risk of oral cancer, nobody is ever ready to face a cancer diagnosis.

Coping with oral cancer diagnosis

Receiving a diagnosis of cancer is upsetting. If you have been diagnosed with cancer, you may inadvertently begin to think that your days are numbered. According to Dr Sanjiv C Nair, Consultant Maxillofacial Oncosurgeon at B M Jain Hospital in Bangalore, the very diagnosis shakes people. People like to live in denial, and when confronted with a diagnosis of cancer, they are devastated. The most difficult aspect is, having to go through surgery of the face or mouth and living with the deformity thereafter. But worrying about the deformity is unneeded since you have the most advanced reconstructive techniques tailor-made for the kind of defect.

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You don t have to cope with it alone. The support from your near and dear ones can help you get through it. There has to be a support system starting with immediate family to friends to cope with the diagnosis of oral cancer, says Dr Nair. You will be counselled and treated by your doctor and his team while your family and friends will help you integrate with society.

Coping with the physical changes caused by oral cancer and its treatment

Oral cancer and its treatment can cause one or more of physical changes which can affect the way you look and feel about yourself. Cancer itself can cause loss of smell sensation and problems with breathing. The renowned Oncosurgeon reveals that the major tumours of the craniomaxillary i.e. head and jaw region affect your sense of smell and it is probably the most difficult to recover from. If you lose your smell sensation due to radiotherapy, you may sometimes be able to recover it.

Physical obstruction of the tumour can cause problems in breathing. If there is a large obstructive tumour in your oral cavity, breathing tubes may be inserted into your windpipe to allow free air entry into your lungs. The surgical hole made in your neck (tracheostomy) needs to be taken care of after that.

Surgery can change the way you look and cause eating difficulty and changes in speech. Your appearance following your oral cancer treatment is largely restorable with the available reconstructive options. Both your bone and soft tissues can be replaced with minimal deviation from how you looked earlier.

How much of your chewing and swallowing functions are affected depends on the organ removed. Tongue, palate and oropharynx (middle part of the throat) are the major organs that can disable your speech and swallowing. Your surgeon will try to restore them with organ preservation surgery and reconstruction of your lost oral tissues. You will be able to return to normal life by recovering the organ functions with the use of dental implants. You will need to follow it up with speech and swallowing therapy.

Chemotherapy and radiotherapy can cause side effects like dry mouth, loss of taste and weight loss. But there are ways to cope with, and manage the changes. To begin with, dryness of the mouth is caused by radiotherapy, says Dr Nair. He also discloses that there are multiple options available to manage dry mouth. There are drugs that minimise the damage to salivary glands in the head and neck. Should dryness set in, you have the options of rehydrating the oral mucosa and use of certain artificial salivary agents. Modern radiotherapy actually minimises the side effects of radiation, he points out. Loss of taste is a common but neglected side effect of chemotherapy. It is a combination of dryness and destruction of taste buds, reveals Dr Nair. But you have hope. The regenerative capacity of these tissues is fast, and you can regain taste and salivary function in six months.

You may find the food repulsive during chemotherapy and the food aversion will eventually show up as malnutrition. The inadequate nutritional intake will cause you to lose weight during cancer treatment. In late stages of cancer, weight loss is attributed to the catabolic (breaking down metabolism) phenomenon. The surgeon reveals that in order to overcome weight loss during the course of treatment, you will be administered food through alternate routes of administration. Liquid nutrition may be delivered directly into the GIT through a catheter (direct enteral feed) or nutrition may be delivered directly into your bloodstream (parenteral feed).

Oral care - before, during and after cancer treatment

Cancer and its treatment affect the tissues in the oral cavity in varying degrees. Hence it is important for you to receive oral care before serious complications develop.Referring to the oral evaluation and care before, during and after treatment, Dr Nair says that the oral cancer regimen is dependent on the type of treatment planned. If you are undergoing surgery, there has to be a general maintenance of oral hygiene. This will ensure prevention of infection during and after surgery. If you have been advised radiotherapy you will require good oral cavity rehabilitation to ensure minimum infection in your oral cavity and facilitate recovery. By reducing infection within your mouth, the chances of death of your jaw bones (post-irradiation necrosis) are significantly reduced.

And then there are some dos and don ts of oral care before, during and after cancer treatment. According to Dr Nair, you need to give up all habits that probably are linked to oral cancer e.g. like tobacco and alcohol cessation once you have been diagnosed with oral cancer. Any other causative factors like sharp tooth or dentures need to be addressed. Your dentist will smoothen out the sharp edges. Maintenance of good oral hygiene is very important. During oral cancer treatment, good oral hygiene will minimise chances of post-operative infection. Regular dental and oral check-ups are the key to identification of oral cancer - both prior and recurrent oral cancer after treatment.

Dr Nair notes that lifestyle changes following oral cancer treatment start with total abstinence from habits that are linked to oral cancer e.g. tobacco (smoked and chewed), alcohol, etc. Maintain good oral hygiene and have a healthy diet. A healthy lifestyle also improves your immunity and provides greater resistance to the development of oral cancer.

Recovery from oral cancer is largely dependent on the stage and grade of the disease, reveals the renowned specialist. If your tumour is smaller and has not spread to other parts of your body, you have over 90% chances of a disease-free survival. The more advanced the stage of the disease, the lesser the chances of survival. Hence of paramount importance is early identification and timely treatment, the doctor reiterates.

According to the surgeon, the ultimate goal of oral cancer management irrespective of the early or late stage is maintaining a good quality of life. With the advent of technology, the use of modern reconstructive options allows replacement of both hard and soft tissues of the head and neck, thereby restoring functions of speech, swallowing and aesthesis.

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